- This for me is where less-resourced countries like Ghana, should be looking for options. We need to believe in ourselves that we have what it takes to slow down this pandemic by limiting community spread. We need to
“If you believe you can accomplish everything by “cramming” at the eleventh hour, by all means, don’t lift a finger now. But you may think twice about beginning to build your ark once it has already started raining”
If there is anything I have come to understand with COVID-19, it is the fact those who plan and invest strategically in health as a whole and focus on public health education have fared much better. The stories of New Zealand and Thailand attest to this fact. In October 2019, when the Global Health Security (GHS) Index report was released, the world was made aware that collectively we were not ready for a pandemic. The introductory statement was damming; “the GHS Index analysis finds no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak. Many countries do not show evidence of the health security capacities and capabilities that are needed to prevent, detect, and respond to significant infectious disease outbreaks.”
To put it in mathematical terms, the average overall GHS Index score among all 195 countries assessed was 40.2 of a possible score of 100. As this pandemic has unfolded, I have been looking at individual countries trajectories and comparing them to the country-specific findings of this report. In doing so, I have come to realise that the countries that are controlling this virus best are those that had scored better than the global average in the areas of health prevention, detecting and reporting, rapid response and health systems. It is understandable that the likes of New Zealand with a Health Expenditure per Capita (HEpC) UD$3937 will out-perform the United States, even though the United States spends almost three times more (US$10,246) than New Zealand, on average on each citizen. However, when it comes to a country such as Thailand with a HEpC of US$247, one cannot help but wonder how they have managed to do so much with so little. The answer to this question to me lies in two critical components of the GHS report.
The first is communications with healthcare workers during a public health emergency. For this component, whilst the global average score was 15.1%, Thailand was one of a handful of countries that scored 100%. This is a clear indication that information and data flow during a health emergency was seamless. This then afforded public officials and health professionals the opportunity to engage the citizenry positively. In dong so, the health information that was provided into citizen was converted in a manner that brought about the required attitudinal and behavioural changes that were needed to ensure protocols were followed and maintained.
The second was the capacity of a country to test and approve new medical countermeasures. Here also whilst the global average score was 42.2%, Thailand had a perfect score of 100%. With a new pathogen like SARS-CoV-2, this was handy such that, it allowed them to assimilate any new information quickly, unlearn any earlier narrative that was unhelpful and relearn the new information that was helpful to keep them safe. An illustration of this is that whilst the World Health Organisation (WHO) was issuing guidance indicating that COVID-19 was not an airborne disease, Thailand relied on the information emanating from the evolving primary science to institute the mandatory use of face-covering in all public places as a means of limiting contagion. As I write, Thailand with a population of 70 million and sharing a border with China where the pandemic originated from has 3246 cumulative COVID-19 cases, 92 of which are active and 58 deaths, the last of which was reported over a month ago on the 7th of June.
If I needed any convincing that the size of a country’s pocket was less important than leadership, strategic planning, education and citizen involvement, this was it. The writing was on the wall based on Thailand’s GHS score that they were prepared for the unknown, what public health practitioners had named “Disease X.”
This for me is where less-resourced countries like Ghana, should be looking for options. We need to believe in ourselves that we have what it takes to slow down this pandemic by limiting community spread. We need to identify effective strategies that will allow for the conversion of all the information we have supplied by way of public education into a level of understanding that produces the attitudinal change we require. We need to understand that for a disease that has no known treatment, cure or vaccine our best arsenal is a well informed and cooperative citizenry.
To achieve this, we can start from the GHS report which gives a snapshot of our scores on these two key parameters. In doing so, we must not find excuses to explain away our low score but a desire to understand the underpinnings of these numbers so we can take action. Looking at Ghana’s scorecard, I see our biggest opportunity around communications with healthcare workers during a public health emergency where the country’s score is 0%. I do because throughout this pandemic, we have heard the narrative of many health professionals and the complaints around communication and data opacity. My view is if we can look at the parameters in that category and improve the score to even 50%, we will be on our way to overcoming the public educational malaise and noncompliance to COVID-19 protocols we have come to accept as the norm.
As an aside, we could also be working on the country’s capacity to test and approve new medical countermeasures. Though Ghana had a score of 75% in this area and did significantly better than the global average score of 42.2%, Thailand has shown that even with a small health budget, 100% is achievable. With that in mind, I believe Ghana with the right approach can achieve a perfect score too. I hope we have enough to go by to tell us that waiting till the eleventh hour to correct our flaws has its demerits.
We cannot continue to blame the citizens for their intransigence at this point. If we are honest, we would know that the writings were on the wall long before this pathogen got to our land. As it is said, “Rome was not built in a day.” However, someone with the presence of mind laid the first cornerstone. I think we need that sort of mind presence to get this right.
Featured Image Courtesy of World Bank Photo Collection
Edited by Winifred Awa
